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Osteoarthritis (OA)
Most common type of arthritis. It is a disease of synovial joints characterized by
- Pathological changes (Alteration in cartilage Structure) - Radiological features (Osteophytes and joint space narrowing) - Clinical consequences ( pain and disability)
Epidemiology
Clinical Features
Symptoms include:
- gradually developing pain - aggravated or triggered by activity, - stiffness lasting < 30 min on awakening after inactivity, and - occasional joint swelling. Signs - Restriction of jont movement - Tenderness - Crepitus
Classification
Primary OA
may be localized usually subdivided by the site of involvement (eg, hands and feet, knee, hip). If involves multiple joints, it is classified as primary generalized OA.
Secondary OA
Results from conditions that change the microenvironment of the cartilage, include
significant
trauma; congenital joint abnormalities; metabolic defects (eg, hemochromatosis, Wilson's disease); infections (causing postinfectious arthritis); endocrine and neuropathic diseases; and disorders that alter the normal structure and function of hyaline cartilage (eg, RA, gout, chondrocalcinosis).
Risk Factors of OA
Obesity, Age, Joint injury, stress on the joints from certain jobs and playing
Pathophysiology
OA is a joint disease that mostly affects cartilage. Cartilage is tissue that covers the bones in a joint. Healthy cartilage allows bones to glide over each
other. It also helps absorb shock of movement. In osteoarthritis, the top layer of cartilage breaks down and wears away.
Pathophysiology
OA begins with tissue damage from mechanical injury (eg, torn
meniscus), transmission of inflammatory mediators from the synovium into cartilage, or defects in cartilage metabolism. which increases production of proteoglycans and collagen.
further stimulates the chondrocytes and synovial lining cells, eventually breaking down the cartilage. cartilage is destroyed, exposed bone becomes eburnated and sclerotic.
interphalangeal (PIP) joints (causing Heberden's and Bouchard's nodes) Thumb carpometacarpal joint Intervertebral disks and zygapophyseal joints in the cervical and lumbar vertebrae First metatarsophalangeal joint Hip Knee
Erosive OA
Erosive OA
- Causes synovitis and cysts in the hand. - It primarily affects the DIP or PIP joints. - The thumb carpometacarpal joints are involved in 20% of hand OA, but the metacarpophalangeal joints and wrists are usually spared.
Diagnosis
X-rays OA should be suspected in patients with gradual
narrowing of the joint space, increased density of the subchondral bone, subchondral cyst formation, bony remodeling, and joint effusions.
required to rule out other disorders (eg, RA) or to diagnose an underlying disorder causing secondary OA.
can help differentiate it from inflammatory arthritides; in OA, synovial fluid is usually clear, viscous, and has 2000 WBC/L.
Improve joint function Keep a healthy body weight Control pain Achieve a healthy lifestyle
Medical Management of OA
Conservative treatment
Education Use of heat Weight reduction Joint rest and avoidance of joint overuse Orthotic devices Isometric and aerobic exercises Massage, yoga, Occupational and physical therapy
Medical Management of OA
Alternative therapy
Pharmacologic Therapy
Symptom management and pain control Medication selection
Drugs
Drug therapy is an adjunct to the physical
program. Acetaminophen NSAIDs, including cyclooxygenase-2 (COX-2) inhibitors or coxibs Muscle relaxants (usually in low doses) occasionally relieve pain that arises from muscles strained Oral corticosteroids have no role. However, intra-articular depot corticosteroids help relieve pain and increase joint flexibility.
suggested to relieve pain and slow joint deterioration; chondroitin sulfate 1200 mg once/day has also been suggested for pain relief.
Surgical Management
Osteotomy- alter the distribution of weight within
the joint
Arthroplasty- disease joint components are replaced
6 months)
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